Provider Demographics
NPI:1679619639
Name:PROFESSIONAL IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIAC SONOGRAPHER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:865-387-7642
Mailing Address - Street 1:7238 AUSTIN PARK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-8240
Mailing Address - Country:US
Mailing Address - Phone:865-387-7642
Mailing Address - Fax:865-573-1701
Practice Address - Street 1:7238 AUSTIN PARK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-8240
Practice Address - Country:US
Practice Address - Phone:865-387-7642
Practice Address - Fax:865-573-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72825246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty